What's the Worst That Can Happen if I Have Gonorrhea?

Gonorrhea is a common sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae bacterium, which is found primarily in sexual fluids from the penis and vagina. It's simple to treat, but gonorrhea has developed some resistance to treatment.

After chlamydia, gonorrhea is the second-most common STD in the United States. The Centers for Disease Control and Prevention (CDC) estimated there were 1.6 million new gonococcal infections in 2018.

Most people who contract gonorrhea have no symptoms and don't know they are infected, which can be problematic. That's why testing is so important.

"If you find out you have gonorrhea, try to stay calm," said Julia Bennett, L.C.S.W., M.P.H., the senior director of digital education and learning strategy at Planned Parenthood Federation of America, based in New York City. "Gonorrhea is usually super easy to cure. Your nurse or doctor will prescribe antibiotics to treat the infection."

Treatment options for gonorrhea

Only one recommended treatment remains for uncomplicated gonorrhea, according to the CDC. It is a single injection into the gluteal muscle (your butt) of an antibiotic called ceftriaxone.

A single dose of ceftriaxone has four advantages:

1. It is highly effective.
2. It has minimal side effects.
3. The bacteria may take longer to become resistant to this antibiotic since the treatment doesn't rely on the patient needing to complete a full course of treatment.
4. Since the treatment works so quickly, it's less likely the infection will be transferred to another person.

What can make gonorrhea difficult to treat?

Uncomplicated cases of gonorrhea are easy to treat, but five circumstances might make treatment more difficult.

Penicillin allergy

Ceftriaxone is an antibiotic in the cephalosporin family. Some patients who are allergic to penicillin are also allergic to ceftriaxone. If this is the case, your doctor may choose a different antibiotic.

Unfortunately, oral gonorrhea only responds well to ceftriaxone. If you have oral gonorrhea and you're allergic to penicillin, your doctor may still prescribe ceftriaxone for you and use other medications to suppress your allergy.

Chlamydia

Doctors recommend testing for chlamydia at the same time as gonorrhea since these diseases often go together.

"STDs tend to travel in twos or threes," said Deborah Lee, M.B.Ch.B., a reproductive health specialist at Dr Fox Pharmacy, an online doctor and pharmacy service in the United Kingdom. "If you are diagnosed with any STD, you are at risk of having another."

The treatment for gonorrhea doesn't work for chlamydia, so people who have both infections will need a second antibiotic.

Pregnancy

Being pregnant itself isn't a complication for treating gonorrhea. An injection of ceftriaxone can safely be given to pregnant women.

Pregnancy complicates things if the patient is also allergic to penicillin, has oral gonorrhea or is positive for chlamydia, since the second-choice antibiotics are not recommended during pregnancy.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a serious complication that can result from gonorrhea.

"Prompt antibiotic treatment is necessary," Lee said. "Those with severe infection require admission to the hospital and intravenous treatment."

She added the treatment for PID is an intramuscular injection of ceftriaxone along with two oral antibiotics.

Antibiotic resistance

Since the 1940s, gonorrhea has been winning the war against antibiotics. In the United States, half of all new gonorrhea infections are resistant to at least one class of antibiotic, which is why the recommended drug list to treat gonorrhea has dwindled to one: ceftriaxone.

Antibiotic-resistant gonorrhea is more common in certain parts of the world and in certain populations, such as men who have sex with men.

Gonorrhea has slowly become less susceptible to ceftriaxone, and it is expected to eventually become resistant. In January 2023, the most highly drug-resistant cases of gonorrhea to date were detected in the U.S. New drugs and treatment options are being studied right now.

The side effects of treatment

Diarrhea is the most common side effect of ceftriaxone. It usually only lasts a few days but can be severe.

Do not take any over-the-counter diarrheal medication without first speaking with your doctor, as it may make the diarrhea worse.

Long-term complications caused by gonorrheal infection

Many people with gonorrhea do not experience symptoms. This means the infection may go undetected until serious complications have developed.

While an antibiotic will kill the bacteria that causes gonorrhea, it doesn't heal any damage that has already been inflicted.

In addition, people with gonorrhea have an increased risk of getting HIV or passing it on to someone else.

Two peer-reviewed studies indicated high-risk heterosexuals and men who have sex with men had "double to triple the risk of getting HIV if they were diagnosed with a nonviral STD such as gonorrhea, syphilis or chlamydia," Lee said. "Similarly, the presence of gonorrhea in the genital tract increases the risk of transmitting HIV. Gonorrhea has been shown to increase the shedding of HIV particles from the genital tract. Treating gonorrhea reduces viral shedding."

Complications for females

• Pelvic inflammatory disease. PID causes inflammation and scarring in the uterus and fallopian tubes, leading to long-term pain, potential infertility and an increased risk of ectopic pregnancy.
• Infertility. The inflammation and scarring of the fallopian tubes can create blockages that prevent eggs from reaching the uterus, making it difficult to get pregnant.
• Ectopic pregnancy. This is a pregnancy that occurs outside the uterus, most commonly in the fallopian tubes. Ectopic pregnancies can be life-threatening and require emergency treatment.

Gonorrhea also complicates pregnancy. If left untreated, gonorrhea can cause:

• Premature rupture of membranes (PROM). "It has long been recognized that PROM is linked to testing positive for gonorrhea at the time of delivery," Lee said.

PROM is associated with other poor pregnancy outcomes such as chorioamnionitis, an infection of the amniotic fluid and membranes inside the uterus, and intrauterine growth retardation when the baby is small for its gestational age, she added.

• Preterm labor. Untreated gonorrhea in the mother is associated with preterm labor and delivery. Babies born before 37 weeks of pregnancy are at an increased risk of health problems.
• Eye infection in newborns. Gonorrheal infections in the eye of a newborn used to be the leading cause of blindness in America. In resource-rich countries, newborns are treated with an antibiotic ointment in their eyes soon after birth to protect against undiagnosed maternal infections.

Complications for males

• Erectile dysfunction (ED). Gonorrhea can cause inflammation of the reproductive organs, including the prostate gland and the tubes that carry sperm, which can lead to general discomfort and painful ejaculations.

Anticipatory pain can cause ED, the inability to maintain an erection sufficient for sexual intercourse. Additionally, inflammation of the prostate can itself be a cause of ED.

• Infertility. Gonorrhea appears to cause fertility problems for males either through inflammation and scarring in the reproductive tract or by affecting the quality or quantity of sperm. Damage to the reproductive tract may not be problematic if it is only on one side.

Gonorrhea versus other gynocentric infections

The symptoms typical of gonorrhea can be similar to other infections. Here's a quick way to tell them apart:

• Chlamydia symptoms are similar to gonorrhea, except the vaginal discharge is yellow or brown, and it has a strong, pungent odor.
• Trichomonas symptoms are similar to gonorrhea, except the vaginal discharge has a fishy smell.
• Urinary tract infections (UTI) symptoms include a burning, tickly feeling in the lower abdomen, frequent and urgent urination, and the feeling you need to go again as soon as you urinate. The urine may have a stronger smell than usual.
• Genital warts appear as a group of bumps in the genital or anal area. The cauliflower-like growth can become quite large.
• Yeast infection symptoms are intense vulvar itching and a thick, white vaginal discharge.

If you're sexually active, use protection with new partners to prevent the spread of STDs. Even with protection, though, you're smart to be tested regularly.

Don't wait for symptoms to get tested because you may never get any. Having no symptoms doesn't necessarily mean there is no infection. If you're not sure, get tested.

You and your healthcare provider can figure out how often you should get tested based on your risk. That includes how common gonorrhea is where you live.

With any symptoms you're unsure of, the safest option is to get tested.